DSM-5 Proposals for Paraphilias: Suggestions for Reducing False Positives Related to Use of Behavioral Manifestations

During each of the revisions of the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders, Workgroups comprised of experts in their respective fields are convened with the goal of considering changes to the diagnostic criteria. Based on my experiences working on the DSM-III-R and DSM-IV revisions, there is a natural tendency for Workgroups to focus on making changes aimed at broadening the diagnostic umbrella of their assigned categories with the goal of increasing diagnostic coverage, i.e., reducing what they consider to be false negatives, an effort which inevitably comes at the cost of increasing false positives (Pincus, Frances, Davis, First, & Widiger, 1992).

In the overall scheme of the DSM, false positives (i.e., erroneously giving a diagnostic label to an individual for whom it is not justified) are problematic because of the unnecessary stigma and inappropriate treatment that may result. However, because of their central role as a proxy for...